Psoriasis is a chronic inflammatory condition that mainly shows on the skin: red, sharply demarcated patches with silvery-white scales. The condition is not contagious. It is caused by a misdirected immune system response that leads to accelerated turnover of skin cells.¹
Psoriasis affects an estimated 2 to 3 percent of the global population. It can occur at any age and often appears for the first time between ages 15 and 35 or after age 50. The condition typically runs in flares — phases with more pronounced skin changes alternate with phases with fewer symptoms.¹,²
More than a skin condition
Psoriasis is often associated with comorbidities — particularly psoriatic arthritis (joint involvement), cardiovascular disease and mental health issues. Modern treatments can achieve largely clear skin for many people.¹
2. Types
Plaque psoriasis (psoriasis vulgaris): the most common type. Typical sharply demarcated, raised, red plaques with silvery-white scaling. Common sites: elbows, knees, scalp, lower back, navel.
Guttate psoriasis: many small, drop-shaped lesions on the trunk and extremities. Often follows infections (especially streptococcal throat infection), particularly in children and adolescents.
Nail psoriasis: affects fingernails and/or toenails — pitting, oil spots, onychodystrophy. Can occur isolated or together with skin psoriasis.
Psoriatic arthritis (PsA): inflammatory joint involvement that occurs in a substantial proportion of people with psoriasis. Joint pain, swelling, morning stiffness. Without timely treatment, joint damage can occur. Typically co-managed by rheumatology.
Sharply demarcated, raised, red patches (plaques) with silvery-white scaling
Itching — for many people the most distressing symptom
Köbner phenomenon — new lesions can appear at sites of mechanical skin irritation (e.g. scratches, sunburn, surgical scars)
Nail changes — pitting, discolouration, thickening
Scalp involvement — common, can be mistaken for dandruff
Joint pain and swelling — sign of psoriatic arthritis
Mental health burden — shame, social withdrawal, depression
4. Causes and triggers
Psoriasis is an autoimmune condition with a genetic predisposition. The immune system triggers an excessive inflammatory response in the skin.¹
Genetics: familial clustering exists. Several genes are involved (e.g. HLA-Cw6). Psoriasis is, however, not a classic hereditary disease — not everyone with the genetic predisposition develops it.
Immune system: T cells and certain inflammatory mediators (especially TNF-alpha, IL-17, IL-23) play a key role. Modern biologics target exactly these mediators.
Psoriasis is a systemic inflammatory condition. People with psoriasis have an increased risk of:¹
Psoriatic arthritis — inflammatory joint involvement; should be recognised and treated early
Cardiovascular disease — high blood pressure, heart attack, stroke; risk is particularly increased in severe psoriasis
Metabolic syndrome — obesity, type 2 diabetes, raised blood lipids
Depression and anxiety disorders — through stigma, itching and chronic burden
Inflammatory bowel disease — Crohn's disease occurs more often in people with psoriasis
6. Diagnosis
The diagnosis is typically clinical — the typical appearance is usually unambiguous. The following can be added.¹
Skin biopsy: in unclear cases for histological confirmation.
Severity assessment:PASI (Psoriasis Area and Severity Index) and DLQI (Dermatology Life Quality Index) are recommended in guidelines for assessing severity and quality-of-life impact.
Joint assessment: with joint symptoms, psoriatic arthritis should be assessed (rheumatology).
Screening for comorbidities: blood pressure, blood glucose, blood lipids, liver values — regularly, especially before and during systemic therapy.
7. Treatment: topical and light therapy
For mild to moderate psoriasis, topical treatments (creams, ointments) and light therapy are first-line.¹
Topical corticosteroids
The most commonly used topical medications. Act quickly and effectively against inflammation and scaling. Should typically not be used long-term on the same area (risk of skin atrophy).
Vitamin D analogues (e.g. calcipotriol)
Often combined with topical corticosteroids. Useful for maintenance therapy.
Calcineurin inhibitors (tacrolimus, pimecrolimus)
For sensitive areas (face, skin folds, genital area) — no risk of skin atrophy.
UV light therapy (phototherapy)
Narrowband UVB or PUVA. Typically delivered in a dermatology practice. Effective in extensive psoriasis.
8. Treatment: systemic therapy and biologics
For moderate to severe psoriasis — or when topical therapy is not enough — systemic therapy is recommended. Modern guidelines (NICE CG153, EuroGuiDerm Living Guideline 2025) define clear or almost clear skin as the treatment goal.¹,³
ConventionalClassical systemic therapy
Methotrexate (MTX)
One of the longest-established systemic agents. Typically taken or injected once weekly. Also effective for psoriatic arthritis. Regular blood tests (full blood count, liver values) required.
Fumaric acid esters
Long established in Germany. Common side effect: gastrointestinal symptoms, especially at the start.
Ciclosporin
Acts quickly but is typically used only short-term (kidney function, blood pressure).
Acitretin
A retinoid (vitamin A derivative). Used less often, can be useful for certain types of psoriasis.
Biologics are biotechnologically produced medications that selectively block specific inflammatory mediators. They have fundamentally changed psoriasis therapy in recent years.¹,³
Anti-TNF: adalimumab, infliximab, certolizumab
Inhibit the inflammatory mediator TNF-alpha. Long established. Biosimilars available.
Anti-IL-17: secukinumab, ixekizumab, bimekizumab
Inhibit interleukin-17, a key inflammatory mediator in psoriasis. High efficacy. Bimekizumab (newer addition) additionally inhibits IL-17F.³
Inhibit interleukin-23. Advantage: longer dosing intervals (sometimes every several weeks or months).
Anti-IL-12/23: ustekinumab
Inhibits interleukin-12 and 23. Long established.
New 2025Small molecules (oral)
Apremilast (PDE4 inhibitor)
PDE4 inhibitor as a tablet. More moderate efficacy than biologics, but oral.
Deucravacitinib (TYK2 inhibitor)
TYK2 inhibitor as a tablet. New addition. Selectively inhibits tyrosine kinase 2 and is therefore distinct from the classic JAK inhibitors.³
Nobody has to live with severe psoriasis today
Psoriasis treatment has fundamentally improved in recent years. If your current treatment is not working well enough, it is generally worth talking to dermatology about modern alternatives.
9. Daily life with psoriasis
Skin care: regular emollient base care — even during clear phases. Often the most important single measure in everyday life.
Avoid triggers: stress, alcohol, smoking and excess weight can promote flares. A healthy lifestyle can have a positive effect on the course.
Medications: regular and punctual intake/application. With biologics: maintain the cold chain, keep injection appointments.
Mental health: visible skin changes, itching and stigma can substantially affect quality of life. Psychological support and patient organisations (e.g. the Psoriasis Association in the UK) can help.
Joint symptoms: with new joint pain or swelling, psoriatic arthritis should be assessed — early treatment can prevent joint damage.
How brite helps you with psoriasis
MTX once a week (always the same day), the biologic every few weeks with a cold chain, plus daily emollient base care — psoriasis treatment has a clear rhythm. brite helps you keep it and avoid mix-ups.
Intake reminder — MTX weekly (a wrong-day mistake can be dangerous), biologic injection appointments every few weeks, fumaric acid ester dose escalation over weeks, apremilast or deucravacitinib daily: brite reminds you on time of every component.
Drug interaction check — MTX plus NSAIDs (kidney risk)? MTX plus trimethoprim/co-trimoxazole (can raise levels)? Biologic plus live vaccine (contraindicated)? Trigger medications (beta-blockers, lithium, ACE inhibitors) flagged? brite shows the critical combinations.
Health journal — track skin appearance, PASI scores from clinic visits, flares, joint symptoms and quality of life (DLQI) over time. At the next dermatology appointment, show objectively how the treatment is really working.
Digital medication plan — all medications clearly organised for dermatology, rheumatology (with PsA) and GP. Important before surgery or vaccination: biologics and MTX must be taken into account.
No. Psoriasis is an autoimmune condition and is not transmissible — neither through touch nor through sharing towels or similar items.
Biologics are biotechnologically produced medications that selectively block specific inflammatory mediators (TNF-alpha, IL-17, IL-23). They are typically given as injection or infusion and can achieve largely clear skin in many people.¹,³
Currently it cannot. Psoriasis is a chronic condition. With modern treatments, however, symptoms can be largely controlled in many people — the treatment goal is the longest possible period of clear or almost clear skin.¹
An inflammatory joint involvement that occurs in a substantial proportion of people with psoriasis. Symptoms: joint pain, swelling, morning stiffness. Without timely treatment, joint damage can occur. Typically co-managed by rheumatology.
Not necessarily — but psoriasis is a chronic condition and relapses are common after stopping. The decision about treatment duration is made individually with dermatology.
Stress does not cause psoriasis but can trigger or worsen flares. Stress management (relaxation techniques, exercise, psychotherapy) can have a positive effect on the course.
Regular emollient skin care, avoid triggers (stress, alcohol, smoking), healthy diet, regular exercise and weight control. With excess weight, weight loss can improve the course.
Generally yes — when there is an indication and conventional treatments are not sufficiently effective or not tolerated. Specific requirements vary by country and insurance scheme; the prescription is made by dermatology.
Medical disclaimer: This article is for general information only and does not replace medical advice, diagnosis or treatment. Psoriasis medications (especially systemic therapies and biologics) require regular medical monitoring. Treatment choice is always individually determined by the treating dermatology team. Last updated: April 2026.
